In the infant population, the complex issues of dysphagia and swallowing remain to be a conundrum when it comes to the care management of this population. The lack of a pathophysiology guided diagnostic and safe feeding management strategies continue to be critical barriers to progress in this field. This proposal will focus on the dynamic changes in the integrative physiology of the neonatal pharynx, upper esophageal sphincter (UES), lower esophageal sphincter (LES) and esophagus during swallowing and GERD. The overall goal of this project is to examine new management approaches of dysphagia in the infant population. This project will address two aims. Aim 1: Effectiveness of two feeding strategies on clinical-, safety- and economic- outcomes in dysphagic infants with anterograde aspiration. The goal of this Aim is to develop novel feeding strategies, to improve clinical outcomes and to clarify aerodigestive protective mechanisms in oral-fed infants (under 6 months of age) with abnormalities proven by diagnostic video fluroscopy swallow study (VFSS). Aim 2: Mechanisms and Impact of feeding strategies on pharyngeal and esophageal sensitivity of aerodigestive reflexes in dysphagia with or without GERD. The goal of this Aim is to differentiate GERD and its consequences by examining the sensory-motor characteristics of the swallow, various reflexes and aero-digestive coordination using manometric studies.